Neurogenic Thoracic Outlet: We No Longer consider it an Obscure Pathology

Introduction: By common consideration Neurogenic Thoracic Outlet is as a kind of obscure pathology, difficult to diagnose and with very poor outcomes.

We rebate this conception presenting the results of our clinical series of 217 cases.

Methodology and Material: Two hundred and 17 cases were operated in our institution and private practice during the past 7 years, unilateral or bilaterally for Neurogenic Thoracic Outlet diagnosed mainly thru evocative test and AngioCAT

Results: In 95% of our cases “excellent” or “good” results were obtained with Scalenectomy + proximal Brachial Plexus Neurolysis + decompression of the 3 possible levels in patients with Neurogenic Thoracic Outlet. Only 1 case did not improve. Most of the complications were related with dysaesthesia from the cutaneous pectoral nerves and phrenic transient neuropraxia. Only 7 first ribs were removed.

We present the most frequent causes of compression we found in our series and discuss our understanding about the etiology of this pathology.

Conclusions: 1.- Neurogenic Thoracic Outlet may be diagnosed with significative clinical certainty thru evocative tests and AngioCAT in neutral and hyperabduction of the extremity

2.- Anterior and Middle Scalenectomy + proximal Brachial Plexus Neurolysis + decompression of the 3 possible levels resolved the previous symptomatology in most of the cases

3.- We do not consider first rib resection as a method for treatment in this pathology